consciouscoder
New
Hi, fellow coders! New coder here with a question about 90792 for mental/behavioral health:
The practice network I work for is pro-fee billing and our providers treat outpatient at our facilities and sometimes treat inpatient at partnered hospitals. Some of our patients have conditions with severe exacerbation requiring hospitalization multiple times in a one year period. Typically we code the first visit inpatient (*not facility coding*) as 90792 to assess mental status, initiate psychiatric care, and any subsequent inpatient visits are coded as 99233 with psychotherapy when documented. Due to payer frequency we sometimes receive denials for situations like billing frequency met/exceeded when a patient is inpatient multiple times per year. Once 90792 frequency is met for the year, assuming MDM is high for the initial assessment, would:
1. 99223 be an appropriate code in place of 90792?
2. *Or* do you appeal the payer for 90792 based on change in mental status? (Any advice on these appeals would be appreciated)
3. When dx are the same but it's a repeat scenario of severe exacerbation + high risk = is 99223 supported?
Thanks for your input!!
The practice network I work for is pro-fee billing and our providers treat outpatient at our facilities and sometimes treat inpatient at partnered hospitals. Some of our patients have conditions with severe exacerbation requiring hospitalization multiple times in a one year period. Typically we code the first visit inpatient (*not facility coding*) as 90792 to assess mental status, initiate psychiatric care, and any subsequent inpatient visits are coded as 99233 with psychotherapy when documented. Due to payer frequency we sometimes receive denials for situations like billing frequency met/exceeded when a patient is inpatient multiple times per year. Once 90792 frequency is met for the year, assuming MDM is high for the initial assessment, would:
1. 99223 be an appropriate code in place of 90792?
2. *Or* do you appeal the payer for 90792 based on change in mental status? (Any advice on these appeals would be appreciated)
3. When dx are the same but it's a repeat scenario of severe exacerbation + high risk = is 99223 supported?
Thanks for your input!!